Letter: Patients know the worth of psychotherapy

Sir: Claims and counter-claims have always been made for the efficacy of the psychological therapies. To prevent malpractice, it is crucial that the public should have access to accurate information about whether talking treatments work.

In this respect Jerome Burne's article ("Therapists - who needs them?", 28 May 1997) is something of a curate's egg. It is true - and has long been known - that psychotherapists are relatively poor at predicting behaviour. It is also the case that their predictions are improved if they utilise actuarial and research-based information, and take care to distinguish between facts and inferences about their patients. However, the article makes the error of assuming that because psychotherapists are poor at performing certain tasks, psychotherapy itself is ineffective, a conclusion at variance with the facts.

The Department of Health has recently published a strategic review of the provision and organisation of psychological therapy in the NHS, as a part of which Peter Fonagy and I were commissioned systematically to review research into the efficacy of the psychotherapies. We noted that there are many forms of psychological therapy, and that though there is more research on some forms than others, there is good evidence that therapies are effective for many people, across a wide range of major mental health conditions - these are not just treatments for people with minor worries.

Though outcomes were at least partly dependent on the skill with which therapies were carried out, we also concluded that many factors contribute to success - we are far from understanding how therapy works, and what therapies work best for each individual patient. If practitioners are realistic they will avoid making inflated claims for their treatments - the best guide will be the response of the patient.

Dr TONY ROTH

University College, London

London WC1